Obesity and psychiatric disorders: commonalities in dysregulated biological pathways and their implications for treatment

Abstract

Rates of obesity are higher than normal across a range of psychiatric disorders, including major depressive disorder, bipolar disorder, schizophrenia and anxiety disorders. While the problem of obesity is generally acknowledged in mental health research and treatment, an understanding of their bi-directional relationship is still developing. In this review the association between obesity and psychiatric disorders is summarised, with a specific emphasis on similarities in their disturbed biological pathways; namely neurotransmitter imbalances, hypothalamus-pituitary-adrenal axis disturbances, dysregulated inflammatory pathways, increased oxidative and nitrosative stress, mitochondrial disturbances, and neuroprogression. The applicability and effectiveness of weight-loss interventions in psychiatric populations are reviewed along with their potential efficacy in ameliorating disturbed biological pathways, particularly those mediating inflammation and oxidative stress. It is proposed that weight loss may not only be an effective intervention to enhance physical health but may also improve mental health outcomes and slow the rate of neuroprogressive disturbances in psychiatric disorders. Areas of future research to help expand our understanding of the relationship between obesity and psychiatric disorders are also outlined.

Keywords: BDNF; BMI; C-reactive protein; CBT; CNS; COX; CRP; HPA; IDO; IFN; IL; Inflammation; Neuroprogression; Obesity; Oxidative stress; PTSD; Psychiatric disorders; TNF; Weight loss; body mass index; brain-derived neurotrophic factor; central nervous system; cognitive behaviour therapy; cyclooxygenase; hypothalamus–pituitary–adrenal; indoleamine 2,3-dioxygenase; interferon; interleukin; post-traumatic stress disorder; tumour necrosis factor.